Conservative therapy for the perforation of duodenal ulcer

Abstract

Surgical repair and drainage was considered to be the first choice for the treatment of perforation of duodenal ulcer (PDU) . Recently invention and development of several drugs resulted change of treatment for the perforation of duodenal ulcer from surgery to conservative therapy. We will report result and problems of 5 cases of perforation of duodenal ulcer treated conservatively.
From 1999 5 cases of duodenal ulcer with perforation were treated conservatively. We employed conservative therapy only for the perforation of duodenal ulcer. Due to the size, general status, conservative therapy was not employed for the patient with perforation of gastric ulcer. Conservative therapy for PDU include following procedures. Initially for the patient suspicious for PDU upper gastrointestinal endoscopy was carried out to confirm the diagnosis. Subsequently nasogastric tube was inserted into the stomach to drainage gastric content. H₂ receptor antagonist and antibiotics was administered with fluid supplement. If response for the treatment was poor, surgical procedures were employed immediately.
4 cases of PDU could successfully recovered from perforation and peritoneitis without surgical procedure. Raise of body temperature improved within 2 or 3 days after initial treatment. One patient who did not respond to the conservative treatment for 2 days needed surgical repair and drainage. Though two days of conservative treatment successfully decreased upper abdominal pain, moderate grade fever did not respond to the therapy. For this patient who could not treat successfully, decompression of gastric content was not carried out immediately after endoscopy. Insufficient drainage of gastric content was supposed to be cause of leakage of gastric content into peritoneal cavity.
We can conclude that PDU confirmed by upper gastrointestinal endoscopy without massive ascites, conservative therapy can be employed. For conservative treatment drainage and decompression of gastric content was essential. Body temperature was key symptom to estimate the response for conservative therapy.